The Anesthesiologist’s Role During Attempted VBAC

Abstract

American College of Obstetricians and Gynecologists' guidelines on vaginal birth after cesarean had both intended and unintended consequences for anesthesiologists. Epidural analgesia continues to play an important role in patient acceptance of a trial of labor after prior cesarean delivery. It does not impact the success rate of vaginal birth after cesarean and may be a diagnostic tool when uterine rupture occurs. Preanesthesia evaluation and counseling should occur early in the patient's care. Intrapartum management includes appropriate oral intake and close communication between anesthesiologist and obstetrician. If uterine rupture or postpartum hemorrhage occur, appropriate algorithms should be followed.

Intrapartum management of trial of labour after caesarean delivery: evidence and experience

“…Consultation with the anaesthesiologist, either antepartum or when the patient is admitted to the labour and delivery suite, and with the other doctors and personnel who will be involved, is also essential. 34 A complete intrapartum management plan should be documented in writing, and reviewed periodically with the woman and her partner during the course of the pregnancy.…”

“…The previous obstetric records and operative notes should be obtained and reviewed for the indication for the initial caesarean, to document the type of uterine incision, and any complications encountered, and to make sure that there are no unanticipated contraindications to VBAC. Consultation with the anaesthesiologist, either antepartum or when the patient is admitted to the labour and delivery suite, and with the other doctors and personnel who will be involved, is also essential . A complete intrapartum management plan should be documented in writing, and reviewed periodically with the woman and her partner during the course of the pregnancy.…”